101. Toward the formation of a Companion Animal Parasite Council for the Tropics (CAPCT)

The CAPCT consists of region-specific e.g., Asia-Pacific, Latin America and Caribbean, Africa experts comprising academics, veterinarians, parasitologists, physicians and allied industry

L E T T E R T O T H E E D I T O R Open Access

Toward the formation of a Companion Animal

Parasite Council for the Tropics (CAPCT)

Rebecca J Traub1, Peter Irwin2, Filipe Dantas-Torres3,4*, Gabriela Pérez Tort5, Norma Vollmer Labarthe6,

Tawin Inpankaew7, Mukulesh Gatne8, Bui Khanh Linh9, Volker Schwan10, Malaika Watanabe11, Susanne Siebert12, Norbert Mencke12and Roland Schaper12

Abstract

This letter advises the imminent formation of the Companion Animal Parasites Council for the Tropics (CAPCT) The CAPCT consists of region-specific (e.g., Asia-Pacific, Latin America and Caribbean, Africa) experts comprising academics, veterinarians, parasitologists, physicians and allied industry partners that will work together to inform, guide and develop best-practice recommendations for the optimal diagnosis, treatment and control of companion animal parasites in the tropics, with the aim of protecting the health of pets and that of the public

Keywords: Dogs, Cats, Parasites, Tropics, Anthelmintic, Deworming, Recommendations, Council, Heartworm

Letter to the editor

The role of companion animal parasite councils

Both the European Scientific Council of Companion

Animal Parasites (ESCCAP) and the Companion Animal

Parasite Council (CAPC) in the United States are

inde-pendent, non-profit making organisations consisting of

experts in the field of parasitology and public health

from across Europe and the United States, respectively

Initially convened in 2002 (CAPC) and 2005 (ESCCAP),

the role of these organisations is to develop

recommen-dations for the optimal treatment and control of

com-panion animal parasites with the aim of protecting the

health of pets and the health of the public by reducing

the risk of zoonotic parasite transmission The websites

comprehensively present the life cycles, diseases,

diagno-sis, control, prevalence and distribution maps of a wide

variety of endoparasites and ectoparasites of dogs and

cats In so doing, the guidelines aim to increase

aware-ness and educate practicing veterinarians and public

health professionals of the most relevant parasites within

each region and provide guidance for specific

best-practice procedures to protect pets and the public from

parasitic infections For the majority of globally distributed parasites that the recommendations for the geographic regions CAPC and ESCCAP represent, there is overlap, owing to commonalities in mode of transmission and risks of exposure of the respective parasites to pets and humans For others that are restricted geographically, for example the trematode Nanophyetus salmincola in the Pacific Northwest of the United States and Canada and Heterobilharzia americana, the cause of canine schistosomiasis in south-eastern United States, information and guide-lines are highly region-specific Whenever possible to

do so, the guidelines put forward by experts of CAPC and ESCCAP are evidence-based, extracted from comprehensive well-resourced epidemiological and clinical-based studies and updated frequently to cover the latest research

The“tropics” are unique

A plethora of arguments stand in favour of developing

best-practice guidelines for the regions spanning Southeast Asia, the Pacific Islands, Northern Australia, South Asia (including India), Latin America and Africa, other-wise known as the ‘tropics’, the geographical area between the Equator and the Tropics of Cancer and Capricorn The region is predominantly characterised

by hot, humid weather, but also includes other climatic

* Correspondence: filipe.dantas@cpqam.fiocruz.br

3 Department of Immunology, Centro de Pesquisas Aggeu Magalhães,

Fundação Oswaldo Cruz, 50740465 Recife, Brazil

4

Department of Veterinary Medicine, University of Bari, 70010 Valenzano, Italy

Full list of author information is available at the end of the article

© 2015 Traub et al.; licensee BioMed Central This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,

zones, namely the seasonally dry tropics, mountainous

and less commonly, arid zones These climatic

condi-tions support a diverse range of pathogens and vectors

of medical and veterinary importance, whose

trans-mission and geographical distribution are closely

linked to regional temperature, rainfall, humidity and

soil type The wet tropics in particular, favour an

unrivalled animal and plant biodiversity The high

bur-den of disease transmission is exacerbated by the fact

that despite varied economic, political and social

histories, almost all of the tropical countries remain

underdeveloped with the majority being classified as

low to middle income countries by The World Bank

(http://data.worldbank.org/about/country-and-lending-groups) Transmission of parasites is therefore

particu-larly high in these less-industrialized nations In

addition, the demographics of dog and cat populations

in these respective regions and countries are far from

being comparable to Europe or North America The

co-existence of true companion animals with

semi-domesticated and stray animals alike, contribute to the

challenge of parasite control programmes Veterinary

awareness and treatment of animals may be lacking and

environmental and sanitary conditions conducive for

their transmission [1, 2] Many canine and feline

para-sites are also important zoonoses including species of

Toxocara, Ancylostoma and Echinococcus The diseases

caused by these parasites are recognised by the WHO/

FAO/OIE as ‘neglected zoonotic diseases’ that form

under the umbrella of ‘neglected tropical diseases’

(WHO, http://www.who.int/neglected_diseases/en) Their

strategic control requires the application of integrated,

multidisciplinary input involving both veterinarians as well

as public health practitioners The term“neglected”

high-lights diseases that affect mainly poor and marginalised

populations in low-resource settings that receive little

attention in terms of investment in research towards their

surveillance, treatment and control [3]

For example, the higher infection pressure of

para-sites within the tropics, as distinct from cooler climes,

can be demonstrated using Toxocara spp (a globally

prevalent parasite) Toxocariasis is an important

zoonosis that may manifest as visceral larva migrans,

ocular larva migrans, or as non-specific, mild

symp-toms referred to as ‘covert’ or ‘common’ toxocariasis

Toxocariasis has been shown through seroprevalence

studies to be especially prevalent among children from

socio-economically disadvantaged populations [4],

especially those within the tropics [5] Seroprevalence

of toxocariasis among children has been reported at

33 % in Kashmir, India [6]; 49 % in the Philippines [7];

between 15.5 and 17.8 % in Brazil [8, 9] and as high as

47.5 % among populations in Colombia [10] This is in

contrast to seroprevalence rates of 2.4 % in Denmark

[11], 6.6 % in Austria [12], 0–4.2 % in children in Spain [13] and 8.6 to 13.9 % in the United States [14] Toxocara eggs are capable of surviving for several years in optimal environments [15] and therefore high concentrations of infective stages are likely to build up

in any area frequented by patent-parasitized dogs Uncontrolled and untreated dog and cat populations coupled with poor sanitation can lead to heavily con-taminated environments Warm climatic conditions provide ideal transmission opportunities, not only to the occasionally-walked apartment-dwelling dog, but more importantly to the child that shares the animals’ environment

Region-specific parasites begets region-specific knowledge

For other parasites, that are more restricted in distribu-tion, knowledge about their impact as an agent of veterinary or human disease relies largely on local research and knowledge The prevalence of these parasites may depend solely on the distribution of region-specific intermediate hosts (vectors) or be strongly influenced by sylvatic factors or anthroponotic behaviours and therefore necessitate more specific guidelines for their diagnosis and control For example, in areas whereDioctophyme renale, the giant kidney worm of dogs is endemic (including South America, China and parts of Southeast Asia), patients may not be appropriately diagnosed or treated if veterinarians fail to consider the parasite as a differential cause of chronic dysuria and haematuria and occasionally, peritonitis In Southeast Asia, control of Clonorchis sinensis and Opsithorchis viverrine relies on educating owners not to provide their animal access to raw fish For others, differences in pre-patent period may also have important implications on timing of anthelmintic administration Ancylostoma ceylanicum for example, has emerged as the dominant species of hookworm in-fecting dogs and cats in the Asia Pacific region with a reported prevalence of between 35 and 72 % in India [16, 17], 92 % in Thailand [18], 52 % in Malaysia [19], 69–77 % in Laos [20, 21], and over 90 % in dogs in Cambodia [22] In addition to causing anaemia in dogs, this hookworm species is recognised as an important emerging zoonosis [22] A specific feature of the biology of A ceylanicum in dogs and cats is its rela-tively short pre-patent period of only 14 days compared with other major helminths [23] In heavily contami-nated environments, anthelmintics with pure adulticidal activity administered at frequencies of any greater than once every three months, as currently recommended on most such products in Asia, will ultimately fail to have

a significant effect on environmental hookworm bur-dens, the frequency of re-infection and therefore the level of morbidity in the animal (as well as in humans)

The importance of distinguishing Dirofilaria immitis

from the relatively benign subcutaneous nodule worm,

Dirofilaria repens in areas where these filarial worms

are co-endemic is critical for companion animal

veteri-narians For example, in Vietnam, northern India and

Thailand, veterinarians must be vigilant in their choice

of antigen test kit for detecting heartworm infection

and with correctly identifying microfilaria in blood

films; and combining these with the individual’s clinical

presentation and ancillary test results, prior to making

a definitive diagnosis of heartworm disease

Further-more, in many of these heartworm-endemic countries

(e.g., Malaysia, Brazil and Vietnam), the compound

melar-somine (registered as an adulticide), is either unavailable

or rarely utilised as part of the heartworm treatment

re-gime Instead,‘slow kill’, using macrocyclic lactones only, a

method strongly discouraged by the American Heartworm

Society (https://heartwormsociety.org), is routinely

practiced throughout the tropics.“Slow kill” is not only

ineffective, but leads to the selection of macrocyclic

lactone resistant sub-populations of heartworms [24]

Changing trend of companion animal ownership

Companion animal populations can be divided into two

major categories - pets (owned and supervised) and

strays Strays may be further classified according to their

dependence on humans, namely unowned free-roaming

(abandoned and feral), and owned free-roaming

(com-munity dogs) [25] In the United States and the

majority of Europe, legislation promoting responsible

pet ownership assures that the majority of companion

animals are indeed ‘pets’ In Europe and the United

States there is one dog or cat to every 3 to 4 households

(https://www.avma.org, 2012; http://www.fediaf.org, 2010)

In contrast, three quarters of the dog population in

developing regions of the tropics may be classified as stray

or free-roaming community dogs These may equate to as

high as 1 dog to 5 people in Kathmandu, Nepal and Bali,

Indonesia; 1 dog to 4 people in the Philippines and Bolivia

and 1 dog to 3 people in rural Mexico [26] These animals

contaminate the environment with excreta that are a source

of parasite eggs and larvae capable of infecting pet dogs

and humans In recent years however, dog ownership rates

in these now developing economies are on the rise, as are

rapid changes in the nature of companion animal

ownership [27] For example, India has one of the world’s

lowest rates of dog ownership: 4 dogs per 1,000 people,

however, in the last 5 years, dog ownership rates have more

than doubled (+58 %) with an estimated pet dog population

of 10 million, the fastest growth rate of the 53

coun-tries surveyed (http://www.euromonitor.com/pet-care,

2014) Similar trends were recorded for the Philippines

(+38 %), Venezuela (+30 %), Argentina (+20 %) and Brazil

(+14.3 %) In these regions, the rapidly urbanising middle

class appear to be working more, earning more and living

in city apartments sharing close relationships with pet dogs The close human-animal bond has undoubted mental and physical benefits [2], however, these come at a potential cost of acquiring parasitic zoonoses

The role and knowledge of veterinarians on the importance of parasite prevention

The benefits of economic growth and affluence also place an increasingly higher expectation and demand on veterinary practitioners by animal owners for improved standards of service in healthcare for their pets, and protection of their family from acquiring zoonoses In developing nations, veterinarians are deemed at the fore-front when managing the risk of zoonotic diseases [28] The profession has an ethical and legal professional duty

of care to diagnose and prevent zoonotic diseases in animals as well as to refer a pet owner to a physician if potential risk of zoonotic disease transmission exists [29], and this responsibility extends to the provision of advice about parasite prevention

Recently, region-specific guidelines for immunization

of dogs and cats were published by the World Small Animal Veterinary Association Vaccination Guideline Group [30] The report highlighted unique challenges faced by companion animal practitioners in Asia, which included insufficient resources for research, training and diagnosis into small animal infectious diseases and limited awareness of veterinarians on global trends on small animal vaccinology Practicing veterinarians in the tropics are likely to face similar challenges with regard

to their ability to accurately diagnose, treat and control companion animal parasites For example, in the United States, Europe and Australia, veterinarians follow guide-lines outlined by CAPC and ESCCAP, for the control of hookworm andToxocara spp in puppies, which consists

of de-worming with appropriate anthelmintics at 2 weekly intervals until 8 weeks of age, and monthly thereafter These recommended‘intervals’ vary according to country For instance, in Vietnam, Philippines and Malaysia veteri-narians often de-worm puppies at 4, 8 and 12 weeks of age, followed by 2 to 4 times annually Recommended de-worming intervals also vary according to local manufac-turers’ guidelines, the perceived ‘risk’ of parasite infection

by the veterinarian, their knowledge of the parasite’s life cycle and its clinical and zoonotic significance In much of the tropics, resources to fund studies to address these issues are limited Nevertheless, the past decade has seen

a moderate increase in the published literature of research associated with companion animal parasites in tropical countries Much of this has been focused on the sur-veillance and control of diseases that are zoonotic (e.g., echinococcosis, rabies, toxocariasis), rather than aiming

to improve health standards of the animals themselves

There is, therefore, a significant gap in our knowledge

about the significance and distribution of clinically

im-portant parasitic diseases of dogs and cats in much of

the tropics Furthermore, the average veterinarian’s

ability to access relevant and up-to-date information

about these diseases for their region is also a major

fac-tor that limits their ability to translate the research into

everyday practice

The combination of warmer climate, enhanced

para-site life cycles, poor environmental sanitation and higher

environmental contamination rates lead to significantly

increased infection pressure for all animals and

poten-tially pose a serious risk to the public This risk extends

to pets that are inadequately treated as puppies and

adults, even if ‘occasionally’ walked outdoors It is the

opinion of the authors that there needs to be questions

raised about the appropriateness of ‘standard’ parasite

prevention protocols currently advocated by most

companion animal clinicians in the tropics and a

para-digm shift in the thinking of veterinarians with regard to

treating dogs and cats

Towards a solution

We propose formation of the Companion Animal

Parasites Council for the Tropics (CAPCT) The

CAPCT will consist of regional (e.g Asia-Pacific, Latin

America and Caribbean, Africa) experts comprising

academic veterinarians, parasitologists, physicians and

allied industry partners that will work together to

inform, guide and make best-practice recommendations

for the diagnosis, treatment and control of companion

animal parasites in the tropics, with the aim of

protecting animal and human health The organization

will seek input through close collaboration with the

practicing veterinarians, medical and public health

professions, regional government and non-for-profit

bodies In addition to biannual meetings, the Council

will organize veterinary and public outreach events in

each region to facilitate transfer of knowledge through

local lectures, workshops, symposia within local

conferences and webinars to primary stakeholders

such as veterinarians and breeders General and

region-specific recommendations for the treatment

and control of companion animal parasites will be

developed and made available through a dedicated,

freely accessible website

Abbreviations

CAPCT: Companion Animal parasites Council for the Tropics;

CAPC: Companion Animal Parasite Council; ESCCAP: European Scientific

Council of Companion Animal Parasites; OIE: World Organisation for Animal

Health; FAO: Food Agricultural Organisation; WHO: World Health

Organisation.

Competing interests

The authors declare that they have no competing interests.

Authors ’ contributions RJT, PI, FDT wrote a substantial portion of the draft manuscript; All others (GPT, NL, TI, ML, BKL, VS, MW, SS, NM, RS) contributed and critically reviewed content All authors have given final approval for this version to be published.

Acknowledgements

We thank Bayer Animal Health for supporting the CAPCT initiative and this publication.

Author details

1 The Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Melbourne, Parkville, Victoria 3052, Australia 2 College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia 6150, Australia 3 Department of Immunology, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, 50740465 Recife, Brazil 4 Department of Veterinary Medicine, University

of Bari, 70010 Valenzano, Italy 5 Hospital Veterinario de Virreyes and Enfermedades Parasitarias, Universidad de Buenos Aires, Buenos Aires, Argentina 6 Programa Institucional Biodiversidade e Saúde, Fundação Oswaldo Cruz, 21040360 Rio de Janeiro, Brazil 7 Department of Parasitology, Faculty of Veterinary Medicine, Kasetsart University, 10903 Bangkok, Thailand.

8 Department Veterinary Parasitology, Bombay Veterinary College, Maharashtra Animal and Fishery Sciences University, Parel, Mumbai 400012, Maharashtra, India 9 Faculty of Veterinary Medicine, Vietnam National University of Agriculture, Hanoi, Vietnam 10 Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Pretoria, Onderstepoort, South Africa 11 Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 UPM Serdang, Malaysia 12 Bayer Animal Health GmbH, 51368 Leverkusen, Germany.

Received: 29 April 2015 Accepted: 1 May 2015

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